Surgical instrument



May 28, 1940. s. J. BLUMENTHAL SURGICAL INSTRUMENT Filed May 20, 1938 ...tu Illl N..wnl

INVENTOR .f4/waa J.' 3M/wwwa d ATTORNEY Patented May 28, 1940 PATENT OFFICEv SURGICAL INSTRUMENT Samuel J. Blumenthal, Brooklyn, N. rY.

Application May 20,

8 Claims.

This invention relates to surgical instruments designed primarily for use in the removalof tonsils or in performing what is commonly termed tonsillectomy by instruments termed tonsillotomes; and the object of the invention is to provide an instrument of the character described having an improvedblade construction with improved means for actuating the several blades employed so as to -materially simplify the perlO formance of the operation soas to render the results more eifective andfool-proof while at the same tirnematerially simplifying the operations of the surgeon in performing the operation; a further object being to provide an instrument of i the character described wherein upper and lower blades or jaw members are employed, each having an independent movement toward and from the crosshead at the free end of the instrument, and within and between which a supplemental cutter blade is movably `disposed and movably independent of the first named blades or jaws but frictionally engaging .thel upper jaw whereby the latter may bereleased from the edges of theeliminating all unnecessary crevices and recesses which would otherwise render the instrument objectionable andat the same timefacilitating the free and simplified use vof the instrument in performing an operation; a further object being to provide means for quicklyv attaching and detaching the various parts of the instrument including a lever action for quickly moving the blade into its 'operative and inoperative positions, and with these and other objects which Will hereinafter appeanthe invention` consists in a device of the class and for the purpose specified which is .constructed 4as lhereinafter more fully described and claimed. v y

The invention is fully disclosed in the following specification, of which the accompanying drawing forms a part, in which the separate parts of my improvement are designated by suitable reference characters in each of the views, and in which:

cleansing and sterilization of the instrument,l

1938, Serial No. 208,983

(Cl. 12S-309) trating the first position of thev lblades in performing an operation.

Fig. 6 is a View similar to Fig. k5 showing the next position of the blades.

Fig. '7 is a view similar to Figs. 5 and 6 showing the next successive positions of the blades.

Fig. 8 is a view similar to Figs. 5, 6 and '7 showing a further position of the blades, and

Fig; 9 is a plan and sectional View of one end portion of the instrument with parts of the. construction broken away. x i

Instruments of the type and kind under consideration, were originally referred to asguillotines, .and are utilized primarilyvin performing tonsillectomy and are not-employed when the particular nature ofthe tonsilis such as to require operation by dissection. It is therpurpose of my invention to provide an instrument of this type and kind, commonly referred to as a tonsillotome which will simplify the performance of operations of the character described and insure a more perfect performance of the operation with the least amount of throat soreness after the performance of the operation and-without danger of destruction to the pillars of the throat at the tonsil. leaving the maximum amount of musculature after theremoval of the tonsil.

In the accompanying drawing, I have shown at l0 the shank or body portion'of the instrument which is in the form of 4an elongated bar preferably rounded on its lower surface and having a flat top surface Il. The outer end of the bar I0 is flattened and widened as seen at l2 to form a support for an enlarged or wider f head I3, the upper surface of which is continuous with the surface ll as will appear in Fig. 2 "of the drawing. This surface or wall is provided with an elliptical aperture I4 in the outer end portion thereof within the curved or semicircular outer crosshead l5. The crosshead I5 is of channelled cross sectional form and opens into v f channelled sides I6 on the head M to form upwardly and inwardly turned flanges. The channelled sides i6 terminate at the inner end of the head as seen at `I'l' and open through the head at this point. to permit movement of blades later described back and forth through the head.

The outer side portions of the channelledcrosshead I5 include a facing I8 preferably of soft metal so as not to injure the edge of the cutter blade, later described, when moved into engagement with the crosshead in the operation of severing the tonsil as later described.

At the rear portion of the body or frame I0 is a downwardly extending handle|9 preferably arranged at a slight inclination and part only of which is shown in the drawing. The handle is of suicient length to provide a siutable hand grip for supporting the instrument in one hand. The upper end of the handle I9 includes side plates 26 which are welded or otherwise secured to the frame bar Ill or may be formed as an integral part thereof if the frame is made from a casting. The plates 26 extend above the surface I I to form between the side plates a channel within whichga top blade 2l, bottom blade 22 and intermediate cutter blade 23 are movably disposed. The upper ends of the plates 26 are provided with bayonet apertures 24 opening through the'upper edges thereof. One of the side plates 26 is provided with projecting ears 25 within and between which a lock bar 26 is pivotally mounted as seen at 2l, note Fig. 4. The bar is adapted to be arranged in part of the bayonet apertures 24 as seen in Fig 1 ofthe drawing and provides means for retainingfthe blades in position and for supporting the T- shaped crosssead 28 of a rod 29 against displacement from the frame or the side plates 20 thereof. The outer surface of the lock bar 26 is milled as seen at 26a to facilitate movement thereof into an open position, the bar being frictio-nally supported in its operative position.

The rod 29 is adjustably coupled with the internally threaded portion of a link 33, the rod 29 being in threaded engagement therewith so as to adjustV the length of the crosshead of the link with respect to the pivot 3| thereof with an operating lever 32. The lever 32 is pivoted as seen at 33 to an enlarged portion 34 arranged atthe inner end of the cutter blade 23, and the parts 29, 36, 32 are normally assembled with the blade 23 or the enlargement 34 thereof to form a unit attachable and detachable as such with respect to the instrument.

The forward end 35 of the blade 23 is sharpened and curved to conform with the curvature of the crosshead i5, the sharpened-or beveled edge extending well onto the sides of the blade as indicated at 35a in Fig. 3 of the drawing so as to insure the performance of a cutting operation throughout the full length of the crosshead I5 or the side portions thereof. By bevellingl the edge of the blade downwardly, the upper surface of the blade 23 will slide freely over the lower surface of the blade 2|, and also keep the severing operation as near the pillars of the throat as possible, thus leaving the least amount of tissue. The end portion 35h of the blade 23 is of a width to i'lt freely within the side channels I6 of the head I3, whereas the remainder of the blade proper is substantially of the same width as the shank I6. The enlargement 34 is narrow and arranged centrally of the inner end of the blade and includes an elongated key portion 36 adapted to operate in an elongated aperture 3l in the corresponding end of the blade 2|, the aperture 3l opening through said end of the blade. Y

Inwardly of theinner end of the blade 2|, the

side edges thereof are extended and twisted to form laterally extending wings or finger piece portions 38 by means of which the blade 2| lmay be moved forwardly by either hand of the operator or from either side of the instrument. The forward end 29 of the blade 2| is enlarged to flt snugly within the channel I6, whereas thek re mainder of the shank of said blade corresponds in Width to the blade 23 and the shank of the tool.

The free edge of the blade 2| or vthe head 39 thereof is curved as seen at 46 to conform with the contour of the crosshead I5. While this end may be blunt or the width carried to the crosshead, in certain types of tools, it is preferred to bevel the upper surface of the head 31 as seen at 4| so as to produce a thinner, but not sharpy edge 40. This construction will facilitate more readily the inversion of the tonsil and at.

the same time will reduce the thickness of the head I3 as a whole and especially at the crosshead portion I5 thereof. j

`The blade 2| is held in position by the crosshead 28V of the rod 29 as well as by the lock bar 26, and this also holds the other blades 22 and 23 in position, the blade 22 otherwise forms an independent unit freely `detachable as is the blade 23 and the blade 22.

The blade 22 has at its outer end an enlarged head 42 generally similar to the enlarged heads of the blades 2| and 23 so as to lit within the channels |6 and be guided thereby.. This blade terminates at-its free end with a curved edge Y43, also conforming to the crosshead I5, as will be apparent. The shank of the'blade 22 is of similar width to the other blades and is provided at its inner endwith an enlarged body 44 having a depending fork-shaped portion 45 and a forwardly hook-shaped topportion 46, the rear. end of which is provided with laterally extending 1inger pieces or wings 4'I` facilitating the movement of the blade 22 at either side of the instrument.

The lower forked end 45 of the block 42 ,ex-

block 44 in holding the blade 22 firmly in position with the edge 43 thereof engaging the tonsil between it and the crosshead I5. i v' In assembling the instrument, the blade 22 is first arranged upon the upper surface of the frame with the yoke 45 spanning the screwV 48 and with the block 44 adjacent the winged nut when in its position adjacent the head 49. After this the other blades 23 and 2| may be arranged separately uponvthe blade 22 'or the blades 2| and 23 may be assembledfwith the forked end of the blade 2| engaging the key 36, and as assembled placed upon the blade 22, after which the free ends lof the respective blades will be moved forwardly and guided into the channels I6. The

crosshead 24 is then moved downwardly and then rearwardly in the bayonet apertures 24. It will be understood, however, that the lock bar'2` is in the open position in the aforesaid operations,

afterwhich the lockbar 26 is moved into closed f position and the respective blades moved rearwardly to fully expose the aperture I4 inthe head I3 of the instrument. y

In this position of the parts, the lever 32 will be in a forwardly inclined position substantially similar to that shown in full lines in Figs. 1 and 2, whereas the wings 38 of the blade 2| will be '5 arranged substantially at the forward end of the screw 48 or where the screw joins the shank proper of the instrument. The instrument is now ready for use, and the tonsil to be severed is pushed through the opening I4 of the head I3, and in this operation, the blade 2| is advanced in the direction of the crosshead I5 by the thumb of the hand grasping the handle I9 while one finger of the other hand is arranged upon the upper surface of the head 39 of the blade 2| adjacent the edge 40 to insure a complete and proper inversion of the tonsil. This operation is continued until the entire tonsil has been inverted and protrudes below the lower surface of the instrument and the tissue adjacent the pillars is supported between the edge 40 and the crosshead I5 so as to irmly but not severely support the tissue in this position. This operation can be controlled by fthe pressure of the thumb upon one of the Wings The result of this operation is indicated in Fig. 5 of the drawing.

The next step consists in moving the bottom blade 22 forwardly by a finger of the free hand and then spinning the winged nut 5G and tightening it sufficiently to firmly and securely hold the tonsil in close proximity to the engagement of the blade 2i with the tissue as above stated, as seen in Fig. 6. After this the lever'32 is grasped and moved backwardly into the dotted line position shown in Fig. l, which operation will move the cutter blade 23 forwardly and sever the tonsil between the two blades 2i and 22 as seen in Fig. '7. After this the thumb is released from the wing 33 of the blade 2|, and the lever 32 is then moved forwardly with a quick stroke, in which operation the retraction of the cutter blade 23 by reason of its frictional engagement with the blade 2I will cause th-e blade 2| to be drawn rearwardly to disengage the throat tissue and thus leave the tonsil supported in the instrument by the blade 22 as illustrated in Fig. 8 vof the drawing, and facilitate the removement of the tonsil from the mouth by the instrument, after which the winged nut 5l! is released and all of the .blades moved rearwardly by a single pressure applied upon either one of the wings 33 which will free the tonsil from the instrument. The instrument is now ready for the repeating of the'above operation for the removal of the second tonsil. i

In the above described rearward frictio-nal movement of the blade 2i, it will appear that sufficient clearance is provided between the rear edge of the blade and the block M, note Fig. l, to permit this free movement, while at the same time the block checks the rearward movement of the blade 2l so as to provide a sufficient opening to free the tissue. In the event that sufficient forward movementl of the blade has not been accomplished to completely sever the tonsil, it will be understood that the blade 2| may be again moved forwardly and the blade 23 advanced forwardly with greater pressure to fully complete this operation. However, by reason of the structure employed., the complete severing of the tiseue is substantially assured. By providing the soft metal lining I8 in the crosshead, an imbedding of the cutting edge 35 of the blade into this metal is provided, which will produce positive severance of the tonsil, as will be apparent.

By providing the adjustable rod 39, it will be understood that the movement of the lever 32 in controlling the operation of the blade 23 may be regulated.

It will be understood thatany suitable means may be provided for quickly moving and supporting the blade 22 in operative position and for holding the same in such position until such time as the tonsil is ejected from the instrument after removal from the throat.

It will of course be understood that the illustrations in the drawing of the tonsill are purely diagrammatic and are not to be considered characteristic of any particular tonsil or throat structure adjacent the tonsil.

Having fully described my invention, what I claim as new and desire to secure by Letters Patent, is:

l. An'instrument of the class described com'- prising an elongated body portion enlarged at the outer end thereof, the enlarged end having a substantially elliptical aperture forming an arcshaped crosshead at the outer edge of said end of the instrument which is of channelled cross sectional form and continuous with channelled sides of said enlarged end, three elongated blades arranged upon and movable longitudinally of said body and having enlarged outer ends operating in and guided in the enlarged channel portion of said body, a handle member at the other end portion of said body, each of said blades having means at said end portion of the instrument for independently moving the same longitudinally of the body toward and from the curved crosshead,

the outer ends of said blades being curved to conform with the contour of said crosshead, one of saidblades being disposed intermediate the other two blades and having a sharpened edge at its free end to form the knife of the instrument.

2. An instrument of the class described comprising an elongated body portion enlarged at the outer end thereof, the enlarged end having a substantially elliptical aperture forming an arcshaped crosshead at the outer edge of said end of the instrument which is of channelled cross sectional form and continuous with channelled sides of said enlarged end, three elongated blades arranged upon and movable longitudinally of said body and having enlarged outer ends operating in and guided in the enlarged channel portion of said body, a handle member at the other end portion of said body, each of said blades having means at said end portion of the instrument for moving the same longitudinally of the body toward and from the c-urved crosshead, thev outer ends of said blades being curved to conform with the contour of said crosshead, one of said blades being disposed intermediate the other two blades and having a sharpened edge at its free end to form the knife of the instrument, said knife blade being movable relatively to the other blades when the free ends of said other blades are disposed in close proximity to said crosshead, and one of said blades being frictionally moved by the knife blade when the latter is moved in the direction of the handle end of the instrument.

3. An instrument of the class described comprising an elongated body portion enlarged at the outer end thereof, the enlarged end having an aperture, an arc-shaped and channelled crosshead at the outer end of the instrument, three elongated blades arranged upon and movable longitudinally of rsaid body and having enlarged and rounded outer ends, a handle member at the other end portion of said body, one of said blades forming the knife of the instrument and -being movable between and relatively to the other blades when the free ends of said other blades are disposed in close proximity to said crosshead, means for operating the knife blade comprising a lever pivotally coupled with the inner end of the knife blade, and an adjustable link for pivotally coupling the lever in connection with the instrument body.

4. An instrument of the class described comprising an elongated body portion enlarged at the outer end thereof, the enlarged end having an aperture, an arc-shaped and channelled crosshead at the outer end of the instrument, three elongated blades arranged upon and movable longitudinally of said body and having enlarged and rounded outer ends, a handle member at the other end portion of said body, one of said blades forming the knife of the instrument and being movable between and relatively to the other blades when the free ends of said other blades are disposed in close proximity to said crosshead, means for operating the knife blade comprising a lever pivotally coupled with the inner end of the knife blade, an adjustable link for pivotally coupling the lever in connection with the instrument body, and means involving a lock bar for supporting the link against displacement from said body.

5. An instrument of the class described comprising an elongated body portion enlarged at the outer end thereof, the enlarged end having an aperture, an arc-shaped and channelled crosshead at the outer end ofthe instrument, three elongated blades arranged upon and independently movable longitudinally of said body and having enlarged and rounded outer ends, a handle member at the other end portion of said body, one of said blades forming the knife of the instrument and being movable between and relatively to the other blades when the free ends of said other blades are disposed in close proximity to said crosshead, means for operating the knife blade Vin both directions, and manually operated means for supporting one of the second named blades in its forwardly extended position.

6. An instrument of the class described comprising an elongated body -portion enlarged at the outer end thereof, the enlarged end having an aperture, an arc-shaped and channelled crosshead at the outer end of the instrument, three elongated blades arranged upon and movable longitudinally of said body and having enlarged and rounded outer ends, a handle member at the other end portion of said body, one of said blades forming the knife of theinstrument and being movable between and relatively to the other blades when the free ends Aof said other blades are disposed in close proximity to said crosshead,

means for operating the knife in both directions, manually operated means for supporting one of the second named blades in its forwardly extended position, the means for actuating the other of said second mentioned blades comprising laterally extending thumb pieces disposed in .close proximity to the handle member of said body, and means for keying the last mentioned blade to the knife blade and for limiting the movement of said blade with respect to the knife blade in one direction.

7.`In a tonsil removal instrument of the class described, the outer end of which is provided with a large opening through which a tonsil to be removed is adapted to be passed, the opening being bounded on its outer side by a crosshead, a blade movable toward and from said crosshead to engage the tissue adjacent the pillars when a tonsil has been inverted through said opening,

another blade independently movable toward and from the crosshead for firmly engaging the tonsil in juxtaposition to, but in slight spaced relation to the engagement of the first mentioned blade with the tissue, means for positively controlling the engagement of the second named blade, and means disposed between the first named blades and independently movable relatively thereto for severing the tonsil intermediate said blades.

8. In a tonsil removal instrument of the class described, the outer end of which is provided with a large lopening through which a tonsil to be removed is adapted to be passed, the opening being bounded on its outer side by a crosshead of channelled cross sectional form, a blade movable toward and from said crosshead to engage the tissue adjacent the pillars when a tonsil has been inverted through said opening, another blade movable toward and from the crosshead for firmly engaging the tonsil in juxtaposition to, but in slight spaced relation to, the engagement of the first mentioned blade with the tissue, means for positively controlling the engagement of the second named blade, means disposed between the rst named blades and movable relatively thereto for severing the tonsil intermediate said blades, and said first named blade being in means whereby the movement of the last named means away from said crosshead will automatically move said blade into inoperative engagement with the tissue to free the instrument from the throat leaving the tonsil suspended in the instrument between the second mentioned blade and said crosshead.

SAMUEL J BLUMENTHAL.

`frict'ional engagement with said last named 

